Coping with a Loss of Independence

Income Replacement Indemnity Following an Employment Injury

Commission des normes, de l'équité, de la santé et de la sécurité du travail

Applying for an Income Replacement Indemnity Following an Employment Injury

Clientele and Requirements
Any worker, as defined in the Act respecting industrial accidents and occupational diseases, who:

  • remains unable to carry on his or her employment for more than 14 full days following an employment injury (see definitions)
  • is not already receiving compensation for the same injury from an agency other than the Commission
Specific terms and conditions apply when the employment injury occurs in a border region or outside Québec.
 
Note
A person who is not considered to be a worker under the Act may nevertheless be entitled to an indemnity in the event of an employment injury if he or she benefits from the optional personal protection provided by the Commission.

To apply for an income replacement indemnity, you or your representative must proceed in one of the following ways:

Electronic Form

  1. Use the Réclamation du travailleur online service (in French only) and submit the electronic form.
  2. Send the required documents by mail or fax to the Commission office responsible for your region. To find a Commission office, you can use the Nos bureaux online service (in French only).
Paper Form
  1. Complete the Worker’s Claim form.
  2. Enclose the required documents.
  3. Send your complete application by mail or fax to the Commission office responsible for your region. To find a Commission office, you can use the Nos bureaux online service (in French only).
Note
In both cases, we recommend that you keep one copy of the form (paper or electronic) for your records and another for your employer. The electronic form must be printed before it is submitted. You can also telephone the Commission to ask to receive a copy by mail once your form has been submitted.

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